Does BIL Need Sugar?

My brother in law (BIL) needs just enough sugar to sweeten his three cups of coffee a day. Beyond that he can do away with sugar.

But BIL, the hedge fund manager, has always chewed candy to relieve the woes of wealth. And lately, with gyrating Wall Street and the stress of possibly losing it all, he is on a hedge-fund-melt-down-candy-binge; he has a bowl of jellybeans on his office desk, a basket of coffee bon-bons in his family room and a box of butter fingers in his car.

Over the years, his waist has expanded, the leather belt has slid down to his pubis and his blubber belly hangs over it. How did the sugar travel from the lips to settle on his hips?

Chemically speaking, BIL is in love with sucrose or saccharose - a sweet, water-soluble carbohydrate - commonly called sugar. The plants acquire their sweetness mainly from three carbohydrates: saccharose, fructose and glucose. The sweeteners often exist in combination; honey, for example, is a combination of all these three sugars. As sweetness goes, fructose is the sweetest of them all; about 173% percent sweeter than glucose while lactose is only 16% as sweet. Several hundred less sweet carbohydrates exist in plants, but none is of commercial value.

Edible carbohydrates generally occur in nature as a combination of two or more molecules. Sucrose is glucose plus fructose; lactose is glucose plus galactose. BIL also eats multi-molecular carbohydrates like starch and glycogen besides many others of more complex structure.

The digestive enzymes break the ingested carbohydrates into absorbable molecules; the enzymes in BIL’s saliva, stomach, pancreas and intestines cleave the carbohydrates into simpler single molecules, which the cells of intestinal lining transport into the blood stream. Next stop is the liver; which under the spell of floating chemicals can convert absorbed carbohydrates into glucose, amino acids and fats. Liver also stores glucose as glycogen, which is a readily available to maintain a steady glucose level in the blood.

Glucose, the final transformed form of almost all absorbed carbohydrates, is the main energy source for muscular activity and cellular metabolism. The tissues pick up glucose from the blood and utilize it in the presence of oxygen (aerobic) or sometimes in its absence (anaerobic) as during prolonged strenuous exercise. The metabolism of glucose produces energy rich phosphate bonds of ATP (adenosine triphosphate).

While fats can substitute as the energy provider for some organs, brain functions only on glucose. Its depletion can damage the brain. For survival, maintaining the blood glucose level with in a narrow range is the result of many interacting hormones. Insulin and glucagon take the lead in this balancing act. Pancreas secrets insulin in response to high blood glucose levels, which brings the sugar level down by pushing it into cells and also converting it into fat. Low blood sugar stimulates the pancreas to secret glucagons. Other hormones like ACTH and growth hormone from the pituitary, steroids from the adrenals interfere with the uptake of glucose by various tissues, thus maintaining the blood sugar level.

If BIL continues to binge, his insulin will fail to clear the blood of excess glucose - termed ‘insulin resistance’- which will trigger his pancreas to produce excessive amount of insulin, which may still not push the glucose into the cells. Now BIL has diabetes.

With continued over indulgence of calories, BIL progresses into a full-blown metabolic syndrome – a deadly combination of high cholesterol, diabetes, hypertension and obesity. It is likely his abdominal circumference will be more than forty inches, which classifies him as a veritable time bomb, ready to implode with stroke, heart attack or cancer.

BIL has to choose between debility and health. The simplest choice is to eat less, give up his job and join an NGO dealing with world hunger. But that also is the most difficult choice.

The other choice BIL can make is to substitute artificial sweeteners, which is useless unless he reduces eating all carbohydrates and other calories; sugar substitutes offer a false psychological comfort in the absence of reduced intake of calories. Cakes and cookies made with artificial sweeteners still carry a load of other carbohydrates. BIL should not worry about their safety. Common sugar substitutes, aspartame (NutraSweet, Equal), Saccharin (Sweet'N Low, SugarTwin), acesulfame K (Sunett, Sweet One) and sucralose (Splenda) are harmless in moderate amounts as suggested by the FDA.

BIL could make an extreme choice. What happens if BIL starves? In this unlikely and not-advisable scenario, he will not die - not right away - if he hydrates himself daily with about 3 liters of water. During the first 48 hours of starvation his liver will pump out glucose from stored glycogen; in about 72 hours he will start using accumulated fat as the primary source of energy. Utilization of fat will produce ketones, which will give him mild nausea and suppress his appetite. But the brain needs glucose, so he will break down his muscle protein and amino acids like alanine to manufacture new glucose. BIL has a reasonable chance to last a few weeks if he behaves like an IRA prisoner who starved himself to martyrdom in 37 days.

There will be one visible benefit, if he survives the ordeal: his belt will be a few inches tighter and it will move up where it really belonged.